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file Data Standards - Flexibility in Code-Sets

  • Posts: 127
2 years 8 months ago #7155 by Attila Farkas
Hello everyone,

I have an update on the Coordinating Table decisions reached last week. There were four areas of interest that required clarity and a decision:
1. Level of alignment to HL7 International’s IPS specification and development strategy for the IPS-CA FHIR baseline
2. Implementation strategy regarding inclusion of the IPS data domains in the summary
3. Strategy and approach to semantic interoperability and data mapping
4. Scope of coverage for Release 1 of the IPS-CA FHIR specifications

The Coordinating table (with representation from all collaborating jurisdictions) reached a unanimous decision that states:
1. The IPS-CA FHIR profile set will be as closely aligned to the HL7 IPS specification as possible in order to allow vendors in Canada to implement Patient Summaries aligned with local needs. This means that every effort will be made to adopt the international specification and analyze its constraints with practical implementations in mind.
2. The HL7 IPS specification lists a number of data domains as mandatory. Patient Summaries have not yet been tested for alignment with Canadian clinical workflows, however, there is evidence of value where Summaries could be generated for data domains other than those listed as mandatory (e.g. communicating an Advance Directive for a patient). In addition, there is also an expectation that jurisdictional policy variations may mandate some or other data domains being required in those locales. Taking all these into consideration and the desire to offer vendor solutions the ability to configure rather than customize PS solutions across the country, the decision was made to relax the cardinality of the data domains from Required to Recommended. This will allow for a single national standard where jurisdictions can still express a desire to require certain domains through implementation guidance, without a need for changing the national standard.
3. There is a recognition that data quality and semantic standardization is a journey not a singularity. Level of adoption and alignment for terminologies across Canada varies for very practical reasons. It is unreasonable to expect that a Patient Summary project can change all that in one release. As a result, the Coordinating Table approved a recommendation to relax semantic bindings of the FHIR profiles to at most Preferred, including allowing free form text for cases where clinical systems struggle to do automatic or assisted mapping to published ValueSets. It is our belief that this will help with market adoption and eliminate or at least significantly reduce burden on physicians while allowing for Data Quality Improvement programs that are based on objective measurements. There is a need for a roadmap of progressively tightening the specification with clearly listed milestones such that the industry has the runway to change and adapt.
4. Given the aggressive timelines of the first phase of the Patient Summary project, it is recognized that we cannot solve for everything in this first release. As a result, after detailed consultation with participating jurisdictions, a national FHIR profile set that covers all Phase 1 data domain implementations will be created as Release 1. The remainder of the IPS data domains and updates to Phase 1 profiles will be followed shortly and will be based on implementation experience. These profiles will be developed over the next few weeks with a reasonable draft available for vendors to review by the of September. The FHIR profiles and Implementation Guide will be available through the Canadian FHIR Registry on Simplifier – mode detail to follow shortly.

We hope that the above decisions will remove some of the unknowns from the ongoing conversation. The project team will organize a webinar on InfoCentral for next week to answer any questions there may be and start to collect vendor and stakeholder feedback, please watch closely the calendar postings in this working group.

Thank you for your patience and understanding,

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  • Posts: 127
2 years 8 months ago #7116 by Attila Farkas
Allison, these are very good points you are raising. The good news is that they have been top of mind in all of our conversations with the policy makers. As Allana pointed out below, it is one of the decision topics for the upcoming Coordinating Table discussions next week. Please give us a few more days and rest assured that there will be clarity and detail coming to this forum very soon. Once a formal position has been proposed we will bring it here for socialization. Thanks again,

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2 years 8 months ago #7115 by Mohamad Kassem
I support Allison's feedback. Also, is MDS applicable to a Composition resource ClinicalDocument profile?

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2 years 8 months ago #7114 by Finnie Flores
Hi Allison. I support your ideas. I have provided similar feedback to the draft document.

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2 years 8 months ago #7113 by Allison Anderson
I am finding it hard to identify the exact data elements on the Draft Patient Summary that are Required vs Recommended vs optional. I understand that you are trying to align with FHIR requirements, but adding another column on the draft patient summary with that information would help EHR vendors identify what areas need to be worked on first, such as the Required elements. If the required data elements are not currently being recorded or mapped (If nomenclature is required) within an EHR than that will add to the work and implementation timeline to comply with the patient summary requirements. The sooner EHR Vendors are aware of this level of detail, the sooner they can understand the scope of work needed to comply. Can clarity please be added to that asap so vendors can determine the scope of additional work needed to meet these new Canadian elements for the patient summary? For Example, the International Patient Summary requires Allergies, Medications, and Problem List but recommends Immunizations, History of Procedures, Medical Devices, Diagnostic Results. The IPS considers the following as optional: Vital Signs, Past History of Illness, Pregnancy, Social History, Functional Status, Plan of Care, Advance Directives. Are you planning to follow the same requirements as the IPS?

Also, getting more granular as to the which data elements within those data classes are being required would be helpful to determine what exact detail is required vs optional.

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2 years 8 months ago #7111 by Allana Cameron
Hi Michael,
Thank you for raising these practical issues about the adoption of coding standards. We have added this as a discussion item on the agenda of the next coordinating table session for a more fulsome discussion with all of the jurisdictions.

We will share the outcome of that discussion here in the working group after the coordinating table session.

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